Provider Demographics
NPI:1225446412
Name:GARBO, CAROLYN (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GARBO
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 NE 138TH LANE
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8550 NE 138TH LN
Practice Address - Street 2:BUILDING 400
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8957
Practice Address - Country:US
Practice Address - Phone:352-425-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL19382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer